Pancreatic cancer is one of the deadliest cancers in the world, and experts warn that by 2030, it could become the second leading cause of cancer deaths in the United States.
This type of cancer, called pancreatic ductal adenocarcinoma, is known for being hard to detect and difficult to treat.
By the time symptoms appear, the disease is often advanced. That is why scientists and doctors are focusing on finding early warning signs that could help save lives.
A new study from Johns Hopkins Medicine has found that even a small enlargement of the pancreatic duct — the tiny tube that carries digestive juices from the pancreas to the intestine — may be an important early sign of pancreatic cancer in people who are at high risk.
The study, published in Gastro Hep Advances in November 2025, suggests that doctors should monitor this change closely, even when no tumor is visible on scans.
Dr. Marcia Irene Canto, a professor of medicine and oncology at Johns Hopkins University School of Medicine, led the research. She explained that the discovery could help detect pancreatic cancer much earlier than before.
“We are identifying pancreas duct dilatation as an early sign of pancreatic cancer in high-risk individuals, even when there is no visible mass,” Dr. Canto said. “This finding may lead to better survival if cancers are detected early.”
The study is part of the long-running Cancer of the Pancreas Screening (CAPS) program, which began in 1998 and tracks people with a family history or genetic risk for pancreatic cancer.
These individuals are considered high-risk because they have multiple close relatives with pancreatic cancer or carry genetic mutations that increase their risk. The CAPS program is supported by several major organizations, including the American Society for Gastrointestinal Endoscopy and the National Comprehensive Cancer Network.
In this latest analysis, researchers followed 641 people at high risk for pancreatic cancer. All participants were regularly monitored using endoscopic ultrasound and MRI scans to detect any early changes in the pancreas.
The team found that participants whose pancreatic duct was wider than 4 millimeters were more likely to develop dangerous changes in their pancreatic tissue, known as high-grade dysplasia, or even cancer. Those with a dilated duct were 2.6 times more likely to progress to cancer, especially if they also had three or more pancreatic cysts.
Out of the 641 individuals studied, 97 showed duct enlargement without any visible tumor blocking the duct. Within about two years, 10 of these participants were diagnosed with cancer or pre-cancerous changes.
The risk grew over time — the study found that people with duct enlargement had a 16% chance of developing cancer within five years and a 26% chance within ten years. Importantly, many of these cancers were found early, when treatment could be more effective.
Dr. Canto emphasized that this discovery gives doctors a new way to identify patients who may need closer monitoring. “By identifying this risk factor early, we were able to intervene more quickly,” she said.
“Even with the best imaging tools, a pancreatic cancer mass may not be visible right away, but we can detect the structural changes it causes.” This means doctors could act sooner, either by recommending surgery or scheduling more frequent scans to track any progression.
The research team also pointed out that duct enlargement can sometimes be spotted incidentally on imaging done for other reasons, such as CT scans ordered for kidney stones or abdominal pain.
Dr. Canto urged doctors to pay attention to this potential warning sign. “The dilatation is a red flag in high-risk patients,” she said. “Providers should be aware that it is something that needs to be addressed right away.”
Looking ahead, the Johns Hopkins team plans to use artificial intelligence to analyze imaging data and clinical records. The goal is to create computer models that can more accurately predict which patients are most likely to develop pancreatic cancer based on subtle imaging clues.
When reviewing the study, experts note that this research represents a step forward in early cancer detection. Identifying pancreatic duct enlargement as a risk factor could help catch the disease before it spreads.
However, more studies are needed to confirm these findings in larger populations and to develop clear guidelines for follow-up care. Still, this discovery provides hope that one day, more people at risk will have a chance to detect pancreatic cancer early — when treatment can make a difference.
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The study is published in Gastro Hep Advances.
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